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Asymmetrical putaminal atrophy in parkinsonism-predominant multiple system atrophy (MSA-P): A case report

Koichiro Mori1,2, Akira Yagishita1, Toshio Shimizu1

  • 1Department of Neuroradiology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan.

Radiology Case Reports
|July 13, 2023
PubMed

Insights

Early-stage Multiple System Atrophy parkinsonian subtype (MSA-P) shows characteristic atrophy and iron deposition in the posterior putamen on coronal FLAIR MRI. This finding may serve as a diagnostic marker for MSA-P.

Area of Science:

  • Neuroimaging
  • Neuropathology
  • Neurodegenerative Diseases

Background:

  • Multiple System Atrophy parkinsonian subtype (MSA-P) is a rare neurodegenerative disorder.
  • Parkinsonism is a key clinical feature, often asymmetrical.
  • Neuropathological hallmarks include posterolateral putamen atrophy and iron deposition.

Observation:

  • A case of early-stage MSA-P with right-dominant parkinsonism was studied.
  • Coronal fluid-attenuated inversion-recovery (FLAIR) MRI sequences were utilized.
  • The left posterior putamen, contralateral to the dominant symptoms, was examined.

Findings:

  • Coronal FLAIR images revealed atrophy and iron deposition in the left posterior putamen.
  • These changes were observed in the early phase of the disease.
  • Posterior putamen atrophy was more conspicuous on coronal FLAIR than axial T2-weighted images.

Implications:

  • The observed putaminal changes on coronal FLAIR MRI correlate with neuropathological findings in MSA-P.
  • This imaging pattern may represent a pathognomonic sign for early diagnosis of MSA-P.
  • Enhanced MRI visualization could improve early detection and management of MSA-P.
Keywords:
Asymmetrical parkinsonismFLAIRLateral medullary laminaePutamen

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